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<br /> "' DOLLDIN, PEAMIT FIPPLICATION � H � ~� .�.�
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<br /> _ �• . . : Rgplicant To Complete This =orm . , , "
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<br /> • ' If more than one buildinq is to be contructed, submit a separate permit applica-
<br /> . , tion for each buildin3. A separate permit kill bc issued For caeh building.
<br /> ' ' Ovaer �=. . _,%� •-Y ' Suilding Addzess �� //-.`r=�,.J. .i� . ,
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<br /> � y �'^ L IIlxk
<br /> + ' • � dddress Z- � '� �� ' � G� ��1� Iat I N I'
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<br /> . City ���,�.,/� Phone� j 7 ?�tX�( Subdibision (Plat) C'�-f= �' '`-::c�.�`i- • . .
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<br /> _ • Ezchitect/Engineer • �_r'-_I.�'� C..�`�1...�.:��^-�:• . �'��.✓;� -r -- . .
<br /> • ' -'� City • Phone Hetics & IIounds (Unplatted) � •
<br /> _ = =y . — _
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<br /> � Contractor ' � Sec. 1t�p. Rge
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<br /> - ' :'.'.'' Yddress ' . ,
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<br /> �. 't City Phone Bnilding Us^_ �/1- 1% 7' ' ' ' ";-=�
<br /> ;}; .. ..�.,:. . . , ` ,,.��*;..,.
<br /> � 'i� � SWte License Na�aber Describe Work to Be .Done .� l �Y r- �� S��p��
<br /> • : �1 Ezpiration Dat� ' � '
<br /> � :,1: I • SRETCft PI.OT PLA.N B�LOSP' - . �
<br /> 1: .� • .. • . ., .• ' .. _ � � :
<br /> IIse of IIuildi.dq
<br /> �. _ " , . ,,, � • �New � Addition ❑ Repair/Renoflel
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<br /> � - . .i . .i . �l . . .
<br /> � �, • . : • Valuation of Constructior. S / S 6 ,
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<br /> � 's . � . .. • .. � .. PLOT P7.�1*I REQIII?2�4L:]TS . : = .
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<br /> ` • i � : "' - . �• • � ' Sisdicate lot size, nane of streets,
<br /> _ . '� ti ��� - ' � •indicate location anfl width o� ,
<br /> ' � J : ;: '- : ��`� �•:�;b�� • 8,.,�,,s, la.ate nroposed ar.d all
<br /> . ,•� • '. y�� .. .� • existing baildiags, shc:o distancos
<br /> � . ��.� . ;)� ''+:.�- � y f79� „ i; - , , to properr.y lines, show cistances
<br /> : d :r,c betveen buildings. �
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<br /> • ; . • i.ot size ,5 0 �--rx � l ��1� �' %.
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<br /> , . . •. .. , , • - , '. Lot area Sq. Ft.
<br /> ' � Sizr_ uf Slrq. Sa. Ft.
<br /> • � a� r' � � • . • . • Number of Stories
<br /> . . ;_ _ � �- � ' : Sasement �
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<br /> ��; " . . . , Signed By �j.., ..i� . �.
<br /> 3' , , . ' � /J \ ! /'
<br /> . _ . .� �-{��t� � �. _ � _ For _
<br /> • , . � . ��'�; . Owner Phone 1 c L 14�! N 1
<br /> „' . DO :IOT SC3ITS B?LOt9 THIS LI:di:-POR CITY US 07L'1 ` �
<br /> Date `.:eceived � IIce• Zone . .
<br /> ' a'lan Check :7ur.Scr � ' Pire 2one �
<br /> • Yaluation Occuoancy Crorn
<br /> P�nit Fee � ' • Type of Construccion '
<br /> •Ylan Check Fee � ' Occupant Load •
<br /> , � 7bta1 Pee Due , SprinY.lcrs Required �
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<br /> Date Issucd ' � „ • ' • • ' '
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